Sugar Sweetened Beverages and Fructose

Chapter summary

Sugar in sugar-sweetened beverages (SSBs) drives metabolic syndrome diseases: heart disease, cancer, inflammation, insulin resistance and poor beta-cell function.
At least 13 meta-studies support the link. Yet there is little political will to control SSBs.
The author’s rule: no more than one sugary drink a month. Fruit juice is as bad or worse.
Drop diet drinks too. Treat them like nicotine patches: perhaps needed in the first month, but something to stop.

SSB intake rises along with obesity, and the effect is under-reported.
SSBs are the largest source of added sugar in the US. They add weight and have little nutritional value.
Weight gain happens because people do not compensate for liquid calories at later meals.
SSBs raise type 2 diabetes and cardiovascular risk independently of obesity.
Fructose metabolism leads to inflammation, insulin resistance, impaired beta-cell function, high blood pressure, visceral and ectopic (organ) fat and harmful blood fats.

SSBs date to the 1760s carbonation of mineral waters. Coca-Cola was created in the 1860s by pharmacist J.S. Pemberton.
US soda use has levelled or fallen since 1990. Fruit juice, “healthy” drinks and bottled water have grown.
Children’s intake is rising. One- to four-year-olds had 165 calories a day from drinks in 1999, which doubled within seven years.
Adults: In the Nurses’ cohorts, women who raised SSB intake gained 8.0kg over the period, against 2.8kg for those who lowered it. European EPIC data show one can a day adds about 0.5kg every four years.
Mechanism: Liquid sugar does not switch off appetite, and isocaloric drinks lead to more energy intake than solid food. Fructose goes preferentially to visceral fat and glucose helps fructose absorption. HFCS is a cheap sweetener in SSBs.
Dr Richard Johnson’s mouse study (water plus glucose) shows the picture is still more complicated.

Industry: Promoters of SSBs say education and exercise are the key, not restrictions on drinks. School education programs have shown limited results.
Public health researchers: Reduce intake. The American Heart Association recommends limiting added sugar to 100 to 150 calories a day (about 35g), which the author notes is still generous.
Study quality: Trial designs and data quality vary, so treat studies with caution. The most reliable are large and long.
Diet drinks: They have no calories, but the intense sweetness may stimulate appetite. Diet drinkers may already be diabetic, which confuses studies.

Water.
Milk. A serving has about 85 calories, half of an SSB, plus protein and calcium.
Tea and coffee without sugar.
Whole fruit in place of juice.

SSBs and fruit juice are equally implicated in obesity.
Removing fructose is not trivial, and some people feel withdrawal-like symptoms at first.
Replace the empty calories with foods that have neither fructose nor simple carbohydrate.

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Malik, V., Willett, W. and Hu, F. (2009) Sugar-sweetened beverages and BMI in children and adolescents: reanalyses of a meta-analysis. Am J Clin Nutr 89:438-9.
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